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Digital SMD: Self-Report Questionnaire
Please fill out this questionnaire to provide the research team with basic information about yourself.
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* Indicates required question
Participant ID
*
Create a participant ID using the first initial of your first name + first initial of your last name + the month + today's date. For example, participant "John Smith" will create "JS0528" on May 28.
Your answer
How old are you?
*
18 - 25 yrs
25 - 34 yrs
35 - 44 yrs
45 - 54 yrs
55 - 64 yrs
65 - 74 yrs
Older than 74 yrs
What is your sex?
*
Female
Male
Prefer not to say
What is your weight (unit: lbs)?
*
Your answer
What is your height (unit: feet & inches)
*
Your answer
What is your ethnicity/race?
*
White/Caucasian
Hispanic or Latino
Non-Hispanic
Black or African American
Native American or American Indian
Asian or Pacific Islander
Other:
Education: What is the highest level of education you have completed?
No schooling completed
Did not complete high school
High school/GED
Some college credit, no degree
Trade/technical/vocational training
Associate degree
Bachelors degree
Masters degree
Advanced graduate work or Ph.D.
Other:
Clear selection
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